Cases in surgery. Cases of strangulated hernia / by James Spence.

  • Spence, James, 1812-1882.
Date:
[1848]
Catalogue details

Licence: Public Domain Mark

Credit: Cases in surgery. Cases of strangulated hernia / by James Spence. Source: Wellcome Collection.

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    my remarks on that case, viz. that 66 ifj along with increased tension of the tumour, we find all the urgent symptoms of strangulation, I think that, in spite of occasional exceptions, such as the case I have detailed, the surgeon will act wisely for the safety of his patient, who, after using active preliminary treatment, proposes and urges the operation being performed.” Case IV.—Strangulated Femoral Hernia—Division of the Stricture, and Re¬ duction of the Bowel without Opening the Sac. Miss R-, the subject of the present case, was first troubled with hernia on the 1st December 1846. On that occasion she was seized with violent vomiting and obstinate constipation, which she attributed to a bilious attack. On sending for Dr Menzies, he discovered a small femoral hernia, which he easily reduced by the taxis ; but although the vomiting ceased on the hernia being reduced, violent pain in the belly supervened, and the constipation continued for some time. Dr Menzies mentioned the case to me as I happened to be attending another case of hernia with him at the time, and from his description of the continued severity of the symptoms, I feared that the bowel might have suffered at the constricted part before reduction. She, however, got better, had a truss fitted to the part, and continued quite well until the evening of the 1st December 1847, when she found that, the bandage having slipt down, the hernia had protruded, and she could not return it. Next morning she felt sick, and vomited whenever she took any fluid. In the forenoon she sent for Dr Menzies, who being ill, Dr Burn saw her, and tried to reduce the hernia by taxis, but failed in doing so. I saw her at his request in the afternoon, five p.m., and tried to reduce the bowel, but could not, though cold and other means were used. As the symptoms were not very urgent, and as Dr Burn had not arrived, I directed her to have an enema, and saw her again at half-past seven p.m. Dec. 2, half-past 7 p.m.—The enema had come away without opening the bowels. She continues sick, vomits whenever she drinks; her tongue dry, pulse sharp and quicker than in the afternoon, and there is pain in the abdomen on pressure. The taxis was again tried after placing her in the warm bath ; but without effect. After some persuasion she consented to submit to the operation, which I performed, assisted by Dr Handyside and Dr Kirk. I made an incision over the swelling, and divided the different coverings down to the sac. As it was my intention to try and relieve the stricture without opening the sac, I dissected the parts over the falciform process of the crural arch, which I divided carefully till I could pass the point of my finger between it and the hernia, and then divided it more freely; but still found it impossible to reduce the contents of the sac from a stricture situated apparently in its neck. As the stricture was evidently at one point merely, as I could draw down more of the sac above it, and as I was unwilling to open the sac if it could be avoided, I raised a thin layer of cellular tissue lying upon the sac, divided it horizontally, and touched the strictured part lightly with the point of my scalpel, when I found that the constriction had been caused by a few filaments of condensed cellular tissue closely adherent to the sac, which had escaped the knife in dividing the fascia propria. The sac was held firmly whilst I reduced its contents, which was now done without the least difficulty; the incision was then closed by sutures, and compress and bandage applied as usual. I gave her a draught of solution of muriate of morphia, thirty-five drops. Dec. 3, 11 a.m.—Has passed a good night, slept well, pulse eighty-four, tongue more moist than yesterday; has had no more vomiting, no pain in the abdomen, bowels not opened since operation. To have castor oil. Dec. 3, half-past 7 p.m.—Bowels freely opened by the castor oil, which was long in acting, and had caused some griping (probably owing to her repeating the dose thrice to obtain a motion) ; skin a little hot, pulse eighty, soft; no pain on pressing the belly, no sickness, headach, or vomiting; to have the opiate